Psychotherapy With Suicidal People : a Person-Centred Approach
Dr Leenaars is a registered psychologist in private practice in Windsor, Canada, and is a member of the Department of Public Health Sciences at the Karolinska Instituted Sweden, and was a member of the Department of Clinical and Health Psychology at the University of Leiden, The Netherlands. He was the first Past President of the Canadian Association for Suicide Prevention (CASP), and is a past President of the American Association of Suicidology (AAS), the only non-American to date.
He has collaborated with 100 colleagues in over 20 nations, and has published over 100 professional articles or chapters on violence, trauma, suicide, homicide, genocide, and related topics.
This book is about unique people—some suicidal and some that died by suicide. The book follows the direction of Henry (Harry) Murray: “Never denigrate a fellow human being in fewer than 2000 words.” The main problem facing this book is the one that is the classical issue of psychiatry/psychology itself: the mind-body problem or the admissibility of introspective qualitative accounts as opposed to objective quantitative reports.
This debate resonates to Windelband’s (1904) division of two possible approaches to knowledge; that is, between the nomothetic and the idiographic. The nomothetic approach deals with generalizations, using tabular, statistical, arithmetic, demographic, quantitative methods, whereas the idiographic approach involves the intense study of individual(s) (particulars).
The latter typically involves the use of qualitative methods, via clinical case study, history, biography, and so on (although at times, as studies of suicide notes show, quantitative methods can also be used). In the study of each unique individual, personal documents are frequently used; for example, treatment notes, medical reports, diaries, autobiographies, third-party interviews and, if I may, suicide notes. The nomothetic approach is well engrained in suicidology, psychology, psychiatry, and science in general.
Keeping in mind that a preface represents a compromise for an author between the press for greater inclusion and the need to restrict oneself to a representative introduction, the idiographic approach may need some further explication.
Gordon Allport (1942, 1962) outlined a classical statement on the advantages of the idiographic approach. Allport (1962) began with the fact that psychology is “committed to increasing man’s understanding of man”, both the general and the particular. This is true whether one is a psychiatrist, psychologist, social worker, medical doctor, psychiatric nurse, crisis counsellor, minister, Elder, or whatever. We are deeply interested in the individual personality—and how to treat that person.
Over a century ago, John Stuart Mill proposed that we make distinctions about the general and the particular in science. He showed that both the general and the unique are critical for science’s development. Mill, Freud, Allport, have all argued that for the study of human events one needs both the general and the individual.
A book is obviously written for the reader, you, and, as a final opening remark, there is one apology: There are no universal formulations in this book on how to respond to highly lethal people. When the subject matter is psychotherapy with suicidal people, we can be no more accurate than the available ways of responding, our subject matter, permits. The yearning for universal treatment laws, understandably, exists.
Yet, as Drs Freud, Lester, Maltsberger, Michel, Shneidman, and Wenckstern advise, the search for a singular universal response is a chimera. There is no cookbook! As for any health clinician, say a cardiologist, the outline for psychotherapy as found in a book is not that simple in the trenches, whether in the therapy room or operating room.
You—the psychiatrist, psychologist, Samaritan, social worker, counsellor, nurse, and so on—must constantly learn. I hope that this book assists, as there is no escape from the following fact: Suicidal people can be treated effectively.